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ith the aging and growth of world population, high prevalence of unhealthy behaviors such as smoking and alcohol
drinking, and increasing unhealthy food consumption and sedentary lifestyles including low physical activity and obesity/
overweight, colorectal cancer (CRC) has become a big burden on global health. Prevention and early diagnosis of CRC through
mass screening is important and practical against CRC. Low compliance for current screening tests affects the effectiveness
of CRC mass screening. An efficient screening protocol with high compliance is needed for CRC mass screening. Systematic
searches were done through Medline and Cochrane Library databases. This review explored the current CRC mass screening
protocols to find a more efficient and practical mass screening protocol and problems suitable for further research. Considering
the current economic crisis and limited available resources, combination of high risk factor questionnaire and immunochemical
fecal occult blood test approach as primary CRC mass screening can currently be used as a risk stratification tool to identify
high-risk populations from the community, especially for medically and economically underserved areas/countries before a new
better test comes. Using serum Pyruvate Kinase Isoenzyme M2 (M2-PK) as primary and colonoscopy as secondary screening test
sounds more efficient with higher compliance than current CRC mass screening protocols.
Recommendations for CRC mass screening are suggested for each risk population based on risk stratification. Serum M2-
PK- may be developed as a promising CRC primary mass screening test. Sequential combination of serum biomarker such as
M2-PK and colonoscopy can be a promising CRC mass screening protocol.
Zheng is MD and Professor of Oncologist in Zhejiang University Cancer Institute and was President of Zhejiang Medical University. Dr. Zhu obtained
Ph.D. in Epidemiology from Johns Hopkins University Bloomberg School of Public Health, M.Sc. from Clemson University, and MD from Zhejiang
University. Dr. Zhu has expertise in epidemiologic methods, application of epidemiologic methods in clinical medicine, public health and other
health sciences including cancer and other chronic diseases, toxicology, food and nutrition, and molecular medicine. Especially, Dr. Zhu has unique
expertise in translating basic research into animal/tissue research and into clinical and population research and interpreting clinical and population
research results using biologic mechanisms from basic and animal/tissue research.
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